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DECISION No

DECISION No. 35/2001/QD-TTg OF MARCH 19, 2001 APPROVING THE STRATEGY FOR PROTECTION AND CARE OF THE PEOPLE�S HEALTH IN THE 2001-2010 PERIOD

THE PRIME MINISTER

Pursuant to the September 30, 1992 Law on Organization of the Government;

Pursuant to the June 30, 1989 Law on Protection of the People�s Health;

At the proposal of the Minister of Health in Report No. 3769/TTr-BYT of June 1, 2000,

DECIDES:

Article 1.- To approve the Strategy for Protection and Care of the People�s Health in the 2001-2010 period, with the following principal contents:

1. Objectives:

a/ General objectives: To strive for all the population to enjoy primary health care services, have access to and use quality health services. All people shall live in safe community, develop well physically and spiritually. To reduce the morbidity rate, enhance physical strength, increase life expectancy and develop our race.

b/ Specific objectives:

- Health-related targets to be achieved by the year 2010:

+ The average life expectancy: 71 years.

+ The ratio of maternal death to reduce to 70/100,000 live births.

+ The mortality rate of under-1 children to reduce to below 2.5% of live births.

+ The mortality rate of under-5 children to reduce to below 3.2%.

+ The percentage of newborns weighing under 2,500 grams to reduce to below 6%.

+ The percentage of malnourished under-5 children to reduce to below 20%.

+ The average height of adolescents to reach 1.60 meter or higher.

+ There will be 4.5 medical doctors and 1 university pharmacist for every 10,000 people.

- To reduce the morbidity and mortality rates due to epidemic diseases. To eliminate widespread epidemics. To minimize the morbidity and mortality rates due to cholera, typhoid, petechial fever, malaria, plague, B hepatitis, encephalitis and sexually-transmitted diseases� To maintain the results of the polio elimination and infant tetanus eradication. To restrain the increasing rate of HIV/AIDS infection.

To prevent, control and manage non-infectious diseases like cardiovascular diseases, cancer, accidents and injuries, diabetes, occupational diseases, mental diseases, poisoning, suicide and diseases caused by unhealthy life styles (drug addiction, alcoholism, obesity�).

- To enhance equity in the access to and use of healthcare services, particularly medical examination and treatment services.

- To improve the quality of medical examination and treatment, functional rehabilitation and health improvement at all medical levels. To apply scientific and technical advances so as to develop our health service to the level of advanced countries in the region.

2. Major solutions:

a/ Regarding investment: including the State�s investment, contributions from the community and international aid�, in which the State�s investment shall play the leading role. To step by step increase the proportion of regular expenditures for health in the total State budget expenditure. To prioritize investment for poor, mountainous, deep-lying and remote areas in prophylactic and traditional medicine activities, primary healthcare activities at grassroots health stations, medical examination and treatment for the poor and social policy beneficiaries, mother and child health protection.

- To experiment new financial mechanisms and policies at a number of hospitals in big cities, striving to achieve self-balancing of regular revenues and expenditures on the basis of health insurance and hospital charges. To adjust the hospital charge rates suitable to expenses, technical investment and professional qualifications at each technical level, suitable to the contribution capacity of the people in each region as well as to the payment ability of each target group.

- To expand the voluntary health insurance coverage; to consolidate compulsory health insurance funds, striving to expand the compulsory health insurance coverage to the entire population.

- To intensify the mobilization and coordination of aid sources, particularly sources of non-refundable technical support aid and concessional development investment loans.

b/ Organizational strengthening:

- To strengthen and perfect the organizational system of the health service, to build and perfect the prophylactic medicine, medical examination and treatment and pharmacy networks along the streamlining direction so as to achieve high effectiveness. To perfect the service�s management mechanism from the provincial to grassroots level.

- To develop regional (inter-district) general hospitals in areas far away from the provincial centers. To maintain and raise the operational quality of inter-commune general clinics in mountainous, deep-lying and remote areas.

- To enhance the capacity of the prophylactic medicine system from the central to grassroots level, particularly the provincial-level prophylactic medicine centers and hygiene and epidemics-prevention teams of rural and urban districts. To strengthen the labor medicine departments and set up occupational disease examination clinics in key industrial provinces and cities. To perfect the network of food safety, hygiene and quality control.

- To strengthen the specialized inspection system.

- To re-arrange the network of, and upgrade the material and technical bases for, health workers-training establishments. To renovate the training content and improve the training quality, reinforce the contingent of teachers and lecturers at several intermediate medical schools so as to develop them into medical colleges.

c/ Promotion of the managerial work:

- To train health organization and management personnel at all levels. To clearly assign the management responsibilities to different medical levels and different localities.

- To enhance the capacity to make plans (long-term and short-term) in different operation domains of the health service. To regularly monitor, supervise and evaluate the results of the planning and implementation activities.

- To well realize the policy of dispatching for definite terms professional health workers to mountainous provinces, deep-lying and remote areas running short of health workers. To combine the military medical service with the civil medical service in the people�s health, especially in areas meeting with difficulties in preventing and combating epidemics and in overcoming natural disaster consequences.

- To continue perfecting the legislation on health; to draft and promulgate the Pharmacy Law, the Ordinance on Foodstuffs, the Ordinance amending and supplementing the Ordinance on Private Medical and Pharmaceutical Practice� To promulgate professional regulations and criteria as well as lists of standard material bases and equipment for professional medical fields. To formulate regimes and policies applicable to health workers working in mountainous, deep-lying and remote areas.

- To raise the medical personnel�s knowledge about State management and laws. To build and perfect the system of health inspectorate capable of discharging their tasks as defined in the Statute of State Medical Inspectorate.

- To well implement the regulations on democracy at all health establishments. To launch emulation movements, especially the building of exemplary good units and individuals in the service.

d/ Development of the health personnel:

- To standardize the training of health workers for each level.

- To train specialized health workers so as to ensure the adequate per-capita number of health workers and the balance between the medical specialties. To step up the training of masters and doctors of medicine, physicians of medical specialty 1 and medical specialty 2 for the provincial and district levels, particularly department and section managers. To send health workers abroad for intensive training in those fields or specialized branches, which Vietnam is not able to train in.

- To re-arrange human resources at provincial- and district-level medical establishments in order to enable the rotary mobilization of medical doctors to work at grassroots medical establishments. To improve the health workers� professional qualifications, raise their sense of labor discipline and professional ethics.

- To proceed to the application of regime of obligatory service in mountainous, remote and deep-lying areas for newly-graduated medical doctors.

e/ Consolidation and development of grassroots medical establishments:

- To ensure 100% of communes to have health stations suited to the economic, geographical, environmental and ecological conditions as well as the medical examination and treatment needs in each region.

- By the year 2005, to strive to achieve: 100% of inter-commune general clinics in mountainous and deep-lying areas to be constructed solidly and have medical doctors; 65% of communes to have medical doctors (of which 50% of mountainous communes to have medical doctors); 100% of health stations have midwives, of whom 60% are intermediate-level midwives.

- By the year 2010, to strive to achieve: 80% of communes to have medical doctors (of which 60% of mountainous communes to have medical doctors); 80% of commune health stations to have intermediate-level midwives; all health stations to have assistant pharmacists in charge of pharmacy and some medical staff who are trained in traditional medicine; 100% of villages and hamlets to regularly have health workers who have received primary or higher medical training. To develop the contingent of medical volunteers in villages and hamlets in delta regions.

f/ Promotion of the prophylactic medicine and health improvement work:

- To continue realizing the objectives of the national program on elimination of social diseases and dangerous epidemics. To deploy the implementation of programs on prevention and control of non-infectious diseases such as cardiovascular diseases, cancer, diabetes, hereditary and innate defects and drug addiction.

- To take initiative in preventing and combating epidemics, preventing widespread occurrence of epidemics. To strengthen the system of epidemiological reporting and surveillance and modernize the system of medical statistics management.

- To draw up plans on the prevention and quick overcoming of consequences of catastrophes, natural calamities, on the prevention and control of accidents and injuries, especially traffic accidents, labor accidents and occupational diseases.

- To raise awareness of health- and environment-related issues at enterprises. To give priority to supervising and treating wastes which cause environmental pollution and badly affect human health such as hospital wastes, plant protection chemicals, etc.

- To enhance the management of food quality, hygiene and safety. To study and actively monitor the situation of foodstuff contamination so as to prevent poisoning and diseases caused by food and drinks. To develop the contingent of food hygiene and safety inspectors and supervisors at all levels.

- To implement the program on reproductive health, safe motherhood, basic obstetric care and family planning services. To strive to reduce quickly the maternal death rate, the abortion rate and the rate of women suffering from gynecological diseases.

- To implement programs on protection and care of children�s health, such as malnutrition prevention and combat, juvenile health, school dentistry, diarrhea prevention and combat, acute respiratory infection, rheumatic heart diseases and parasites.

- To promote the movement "The entire people practice physical exercises and play sports, improve health and raise the Vietnamese�s stature."

g/ Medical examination and treatment:

- To invest in comprehensively upgrading the medical examination and treatment network suitable to the needs and socio-economic capability in each region. To assign professional and technical responsibilities to each level and issue strict regulations on the transfer of patients from one level to another. To complete soon the planning on the medical examination and treatment network, increase the numbers of patient beds in provinces where the proportion of patient beds to the population remains low. To standardize the medical equipment and techniques, make the effective and full use of medical equipment in medical diagnosis and therapy. To make lists of medicines suitable to the hospitals� needs and encourage the use of home-made medicines. To fight wasteful use and abuse of expensive medicines and high-tech equipment in the medical diagnosis and treatment. To continue pushing up and intensifying the functional rehabilitation and the prevention of disease sequelae.

- To well implement the hospitals� regulations, to reform administrative procedures in the medical examination and treatment. To ensure conditions in service of patients at medical examination and treatment establishments, especially such essential matters as patients� meals and clothes, sanitation and order at these establishments.

- To diversify medical examination and treatment activities, including - medical establishments of the State and branches, semi-public, private and foreign-invested medical examination and treatment establishments.

h/ Development of the traditional medicine and pharmacy:

To continue implementing well the Prime Minister�s Directive No. 25/1999/CT-TTg of August 30, 1999 on stepping up the traditional medicine and pharmacy activities.

i/ Medicines and medical equipment:

- To continue implementing the "national policy on medicines" with the basic objective of ensuring the constant and adequate supply of quality medicines for the people and the safe, rational and effective use of medicines. To consolidate and strengthen the organizational system of the State management over pharmacy from the central to local level.

- To re-plan and re-organize the pharmacy industry along the direction of concentration, specialization and prioritized investment, ensuring efficient investment. By the year 2010, all pharmaceutical production units must meet the GMP standard. To modernize the medicine distribution network, with importance attached to rural, mountainous and deep-lying areas.

- To perfect the system of legal documents on medical equipment; to build medical equipment and technical service centers and strengthen their organization. To invest in supplying modern equipment for different technical levels of the medical examination and treatment system. To develop the medical equipment industry in Vietnam.

j/ Development of medical science, technology and information:

- To step by step modernize the image diagnosis techniques, bio-chemical, bio-physical diagnosis, immune, hereditary and biological molecule diagnosis techniques. To apply advanced techniques and technologies to the treatment of cardiovascular diseases, endoscope, orthopaedy, microtomy, viscera substitution and transplantation. To build several standard laboratories and three specialized centers in the Northern, Central and Southern regions for foodstuff quality, hygiene and safety testing.

- To develop bio-technologies, especially the genetic technology, the multiplication and tissue culture and transplantation technology in service of the production of medicines, vaccines and bio-preparations for medical diagnosis and therapy. To develop the automation technology in the manufacture of essential medical equipment, the treatment of hospital wastes and the administration and management of hospitals.

- To continue perfecting and improving the effectiveness of the operation of two specialized health centers in Hanoi and Ho Chi Minh cities; to put into operation soon the specialized health centers in Hue and Da Nang and other regional health centers.

- To consolidate the system of reporting and statistics, management information and to supply timely and reliable information for the managerial work at different levels.

k/ Socialization of the medical work:

- To continue promoting the implementation of the Government�s Resolution No. 90/CP of August 21, 1997 on the orientation and policy on the socialization of educational, medical and cultural activities. To incorporate the people�s requirements for health protection and care into the macro social and economic policies, programs and projects on production development, job creation, hunger elimination and poverty alleviation.

- To diversify the healthcare forms, to seek for and utilize various investment sources for the health service, such as voluntary health insurance, foreign aid, etc. To build exemplary models in environmental hygiene and community safety.

- To continue strengthening and developing health communication and education centers in the provinces and cities. To develop the network of communicators in communes. To use appropriate communication measures and forms to involve people of all strata and mass organizations in voluntarily participating in and contributing to the protection of their own health and the community health.

3. Implementation funding:

a/ Annually, basing itself on the assigned tasks of implementing the Strategy for Protection and Care of the People�s Health in the 2001-2010 period, the Ministry of Health shall draw up cost estimates and send them to the Ministry of Finance and the Ministry of Planning and Investment for consideration and incorporation into the annual budgets to be submitted to the Government, then the National Assembly for approval.

b/ The People�s Committees of the provinces and centrally-run cities shall take initiative in allocating the annual budgets to the localities for achieving the objectives and performing the tasks of protecting and caring the health of the population in their respective localities.

4. The program implementation duration: From 2001 to 2010.

Article 2.- The Ministry of Health shall assume the prime responsibility for implementing the program and coordinate with the concerned ministries and branches (Science, Technology and Environment; Planning and Investment; Finance; Aquatic Resources; Agriculture and Rural Development; Industry; Trade; Education and Training; Culture and Information; and Public Security) in planning, guiding, supervising, monitoring and summing up the annual implementation of the program and reporting it to the Prime Minister; organize the preliminary review of the program implementation by mid-2005 and final review of the program implementation by 2010.

Article 3.- This Decision takes effect 15 days after its signing.

Article 4.- The ministers, the heads of the ministerial-level agencies, the heads of the concerned agencies and the presidents of the People�s Committees of the provinces and centrally-run cities shall have to implement this Decision.

Prime Minister
PHAN VAN KHAI